Vitamin supplements and you Guidance for pregnant or breastfeeding women, babies and young children Health Improvement
About this leaflet Vitamins are really important they are essential nutrients that your body needs, in small amounts, in order to work properly. You may have read or heard lots of information about what vitamins you need when you are pregnant or breastfeeding, or what you should be giving your baby or young child. This leaflet explains the recommendations for vitamin supplements for: women who are planning to get pregnant pregnant women breastfeeding women babies and young children. Vitamins are essential nutrients that your body needs, in small amounts, to stay healthy and well. Most people should be able to get all the nutrients they need by eating a varied and balanced diet, including at least five portions of fruit and vegetables a day. However, sometimes people may not be getting all they need for example, women who are planning to get pregnant, who are pregnant or breastfeeding, and babies and young children. In these cases, you might need to take a supplement containing certain vitamins to make sure you are getting enough. 1
Planning a pregnancy, and pregnant or breastfeeding women If you are planning a pregnancy, or if you are pregnant or breastfeeding, there are particular vitamins you should take. These will help to make sure that your body is getting everything it needs during pregnancy and breastfeeding, and will help your baby develop healthily. Folic Acid? Who is it for? All pregnant women and women planning a pregnancy. What does it do? Taking folic acid before you are pregnant and until the 12th week of your pregnancy reduces the chance of your baby being born with a neural tube defect such as spina bifida. This is a birth defect where the spine does not form properly. You should start to take folic acid when you are planning to become pregnant. However, if you did not take folic acid before you conceived, you should start taking it as soon as you know you are pregnant, and should continue to do so until the 12th week of pregnancy. Folate is the natural form of folic acid, found in food. It can be difficult to get enough folate from food alone, so taking a supplement containing the recommended amount of folic acid is very important. You should try to eat plenty of foods that contain folate (see the examples on page 8) as well as taking a supplement. 2
How much do you need? We recommend that all women who are planning to get pregnant and those who are already pregnant take 400 micrograms (sometimes written as mcg or μg) of folic acid each day up until the 12th week of their pregnancy. If you have already had a pregnancy affected by a neural tube defect, you will need to take 5 milligrams (mg) of folic acid each day until the 12th week of pregnancy. If you have diabetes or are taking anti-epileptic medicines, you should consult your GP for advice, as you may also need to take a higher dose of folic acid. Vitamin D Who is it for? All pregnant and breastfeeding women. What does it do? Vitamin D regulates the amount of calcium in the body, which helps to keep bones and teeth strong and healthy. It is important that you take a vitamin D supplement while you are pregnant and breastfeeding to keep your bones healthy and to provide your baby with enough vitamin D in their first few months. There are only a few food sources of vitamin D (see the examples on pages 8 and 9). The best source of vitamin D is summer sunlight, so during the winter months it can be particularly difficult to get enough. 3
The amount of time you need in the sun to make enough vitamin D is different for every person and depends on things such as skin type, time of the day and time of the year. But you don t need to sunbathe: remember to always cover up or protect the skin before it starts to turn red or burn. All pregnant and breastfeeding women, particularly teenagers and young women, are at risk of vitamin D deficiency. You are more at risk if: you are not exposed to much sun - for example, if you cover up your skin, are housebound, or are confined indoors for long periods you are of South Asian or African-Caribbean descent, or have darker skin, because your body does not produce as much vitamin D in response to sunlight. All pregnant and breastfeeding women are advised to take a daily vitamin D supplement. 4
How much do you need? We recommend that all pregnant and breastfeeding women take a daily vitamin D supplement of 10 micrograms. If you are in any doubt about taking vitamin supplements during your pregnancy or while you are breastfeeding, speak to your GP or a health professional. Warning: If you are pregnant, you should avoid supplements containing vitamin A (retinol) this will include some multivitamins as too much of it can harm your baby s development. You should also avoid liver and liver products (including fish liver oil), as they are high in vitamin A. Babies and young children It is important that all babies and young children get enough vitamins to keep them healthy and to help their growing bodies develop. The UK Department of Health recommends that you give your child vitamin drops containing vitamins A, C and D between the ages of six months and five years, unless they are drinking 500ml (about a pint) or more of infant formula a day. Infant formula has vitamins and minerals added to it. 5
Vitamin D Vitamin D regulates the amount of calcium in the body, which keeps bones and teeth strong and healthy. It is particularly important that all babies and young children get enough vitamin D; a deficiency of vitamin D could cause their bones to soften and can lead to rickets. The best source of vitamin D is summer sunlight, so it can be difficult for children to get enough during the winter months. All children under five years old are at risk of vitamin D deficiency. They are more at risk if: they have limited skin exposure to sunlight they are of South Asian or African/Caribbean descent, or have darker skin, because their bodies do not produce as much vitamin D in response to sunlight. 6
Breastfed babies should be given daily vitamin D supplements from 6 months. If the baby is having infant formula, a daily vitamin D supplement should be given if they are receiving less than 500ml (a pint) a day. Taking a vitamin D supplement throughout pregnancy and while breastfeeding will ensure that you have enough vitamin D for your baby during their first few months. If you are breastfeeding and you did not take a vitamin D supplement during pregnancy, your health professional may advise you to give your child a vitamin D supplement from one month and continuing until they are five years old. 7
Vitamin A Vitamin A is important for babies and young children. It helps strengthen their immune system, can help their vision in dim light, and supports healthy skin. Vitamin C Vitamin C is important for your child s general health and their immune system. Remember, you should also try to get your vitamins from good food sources: Folate: Brussels sprouts, spinach, spring greens, broccoli, green beans, oranges and yeast extract. Vitamin A: cheese, eggs, oily fish* (such as mackerel, salmon or sardines), milk, carrots, dark green leafy vegetables, fortified margarine and yoghurt. Vitamin C: oranges, kiwi fruit, strawberries, broccoli, Brussels sprouts, sweet potatoes and peppers. Vitamin D: oily fish*, eggs, fortified margarine and breakfast cereals. But remember, the best source of vitamin D is summer sunlight. * Although you should not have more than two portions a week if you are pregnant or breastfeeding. 8
Where can you get vitamin supplements? You can get vitamin supplements from the following places: Your GP may be able to prescribe vitamins in some circumstances Community pharmacists, who can offer advice on products available for sale over the counter Ask your Midwife or Health Visitor for more information. Alternatively, talk to your GP or community pharmacist. The text from this leaflet has been taken with permission from a booklet produced by COI for the UK Department of Health entitled Vitamin supplements and you ref: 302159 (Sep 11). 9
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The information in this document can be provided in large print or on audio tape on request. Department of Health Public Health Directorate Cronk Coar Noble s Hospital Strang Douglas Isle of Man IM4 4RJ Tel: (01624) 642645 Email: publichealthresource.dh@gov.im Web: www.gov.im/publichealth Copyright: Departrment of Health, Isle of Man Government 2012 Ref No. HEA04 01/12